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Metabolically Healthy Obese: an Oxymoron?

Wednesday, February 04, 2009 Posted by Peter Janiszewski, PhD

To date, countless epidemiological studies have shown that as you move from a normal weight (BMI = 18.5-24.9 kg/m2) towards overweight (BMI = 25-29.9kg/m2) and obesity (BMI ≥ 30kg/m2) the risk of many diseases increases exponentially.


Does this mean that every individual carrying excess weight (overweight or obese) is bound to have diabetes, cardiovascular disease, cancer, or some other disease?


Although that is the commonly held belief, the answer to the above question is a resounding “NO!”


In fact, research suggests that approximately 25% of obese individuals ­are perfectly metabolically healthy (normal blood glucose, blood lipids, blood pressure, and cytokine profile) despite their excess weight.


In the 1980’s when researchers first noted this type of obesity they coined these individuals, Metabolically Healthy Obese.


The defining characteristics of the metabolically healthy obese phenotype, in contrast to obese individuals with metabolic risk, include limited abdominal, particularly visceral fat accumulation, an earlier onset of obesity (<20 years) and high levels of physical activity.

For example, yesterday Travis discussed the notion of sumo-wrestlers who are very obese and yet due to their high level of activity have very little visceral fat accumulation, tons of muscle mass, and a healthy metabolic profile – until they stop training, that is. During their training period, sumo wrestlers much like non-retired football linemen exemplify the metabolically healthy obese phenotype.


As a caveat, there of course are other health issues brought on by carrying excess weight that are not always metabolic (i.e. joint problems due to excess load).


Nevertheless, it is important to note that excess weight alone doesn’t absolutely guarantee the presence of metabolic disease. This once again reinforces the notion that there is more to health than the number on one’s bathroom scale.


Peter

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5 Response to "Metabolically Healthy Obese: an Oxymoron?"

  1. Darya Pino Said,

    But aren't there other forms of health to be concerned about besides just metabolism? What about the huge increase in cancer risk associated with obesity? Breast cancer, for example.

    Posted on February 4, 2009 at 1:23 PM

     
  2. Darya Pino Said,

    BTW, best picture ever :)

    Posted on February 4, 2009 at 1:24 PM

     
  3. Peter Janiszewski, PhD (Cand.), MSc Said,

    Darya,

    Excellent comment - exactly why I stated that caveat in the post - only using joint problems as the example.

    Of course being metabolically healthy doesn't mean obese individuals are immune to other types of diseases - neither are lean individuals. Nevertheless, when you consider the disease burden of obesity, the 2 most common forms of disease that come to mind are diabetes and cardiovascular disease - both largely a consequence of defective metabolism.

    Additionally, while the relationship between obesity and cancer is beyond my area of study, I know that this relationship is at least partly mediated by altered metabolic and inflammatory profiles common among obese. To use your example of breast cancer - disordered glucose metabolism is associated with a higher risk of breast cancer. Thus obese individuals who have normal glucose metabolism, may in fact have a lower risk of breast cancer than predicted based on BMI alone.

    My point was simply to not forget that outliers exist for any relationship in health outcomes - i.e. not every person with a high BMI will get diabetes or heart disease.

    Posted on February 4, 2009 at 2:34 PM

     
  4. Darya Pino Said,

    Thanks Peter! Of course there are always outliers and that is important to keep in mind. In particular I was thinking of how fat works as an endocrine organ, producing estrogen that promotes breast and other forms of cancer.

    Endocrine imbalance is a power cancer causing agent, so it is something to keep in mind for people who are trying to gauge their health.

    You make a great point though!

    Posted on February 4, 2009 at 9:40 PM

     
  5. Lauri Said,

    Thank you. I am overweight, my doctor says 30-40lb weight loss would suffice, I'd be happier with 50lbs off, but my fasting blood sugar level is 51, my BP 115/75. I have n o health issues, not even joint problems, but many people, including insurance companies assume I am on a collision course with death. Well, eventually, but not from a metabolic disease. As for breast cancer, the 4 women I know with it all all thin.

    Posted on May 27, 2009 at 9:10 PM

     

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We are PhD students in the School of Kinesiology and Health Studies at Queen's University in Kingston, Ontario. Our research focuses on the relationships between obesity, physical activity, and health risk. This blog is our attempt to consider the many "cures" for obesity that we read about on a daily basis. Enjoy.

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The opinions expressed here belong only to Peter and Travis and do not reflect the views of any organization. Any medical discussion on this page is intended to be of a general nature only. This page is not designed to give specific medical advice. If you have a medical problem you should consult your own physician for advice specific to your own situation.

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